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Full text of "Diseases Of The Nose Throat And Ear"

CHAPTER 70
CONDITIONS PRODUCING VERTIGO

MENlfcRE'S DISEASE

Meniere's disease is characterized by deafness and tinnitus, as well as
vertigo, loss of balance, nausea, vomiting and nystagmus, and thus involves
both the cochlear and vestibular apparatus.

As the lymphatic spaces of the inner ear are continuous, it seems almost
impossible to conceive of an isolated affection of the cochlear or vestibular
apparatus. On the other hand, the cochlear and vestibular nerves may be
affected separately by toxins with a specific affinity for one or the other
division. Vertigo has been defined as a fals.e-&ens.e..ofLQrientation ofpurselves
inj:MatioiiJ.o.-.Qur~eiiviFoeinent. The patient feels 'as if' he were moving, or
'as if his surroundings moved, while realizing that such interferences are
really erroneous. If the attack is severe the patient staggers, and unless he can
grasp some fixed object he may fall, but he does not become unconscious.

AETIOLOGY. It has been shown that there is a distension of the endo-
lymphatic system in Meniere's disease. This has come to be regarded as
being due to recurring failure of the regulating mechanism concerned with
the production and/or disposal of endolymph. However, the precise cause
of the hydrops has not yet been determined. The numerous theories may
conveniently be grouped as: focal infection: allergy: vasomotor: physical,
i.e. increased endolymphatic tension per se from distortion of the endo-
lymphatic system or rupture of some part of the system; biochemical, which
may also be concerned with the mixing of the endolymph and perilymph
due to rupture of the endolymphatic membrane. Vasomotor theories are
probably the most generally acceptable, but the cause of the condition is
speculative.

SYMPTOMS. The outstanding features are vertigo, vomiting, tinnitus and
deafness. The onset of the giddiness is sudden, usually without warning,
and may render the patient completely helpless within seconds of the onset.
The patient may fall if support is not at hand, and may injure himself.
Vomiting may accompany the dizziness or may follow it. There is frequently
a feeling of tension in the head or tinnitus during the attack, and this passes
off afterwards. Similarly deafness may occur during an attack, but with
recurrence of the attacks deafness becomes established, and is progressive
in most cases. It is characteristic that the attacks frequently waken the
patient from sleep in the early morning. Between attacks clinical and coch-
lear examination may be completely negative, and the diagnosis may have
to be assumed after a careful consideration of the history.

The typical attack may be modified in that instead of vertiginous episodes
there may be a constant sense of imbalance with occasional exacerbations

377